Practical guidelines for developing new palliative care services: resource management.

The data are relatively clear cut that palliative care improves quality of life and symptom control, improves quality of care by reducing aggressive but unsuccessful end of life care, and reduces costs. That should be an easy message to deliver to the public, health care administrators, payers, and governments. In fact, the arguments to develop palliative care services must be clear and concise, and make the clinical and financial case for the services that the palliative care team wants to deliver. Here, we discuss some of the types of models including consult services, outpatient programs, and inpatient units; the important components; some easy to use screening tools; components of the consultation team; a model medical record that increases "prompts" to do best palliative care; and data to report to supervisors.

GMHC volunteers and the challenges and hopes for the second decade of AIDS.

A documentation of the impact of AIDS on New York City during the first decade of the epidemic must highlight the extraordinary responses of the Gay Men's Health Crisis (GMHC) and other community-based organizations. Data collected from volunteers (n = 587) at the close of this decade are presented to address concerns about how successfully an organization such as GMHC will be able to confront the challenging future of the epidemic. Questionnaire data on demographics and prior AIDS experiences and responses to a GMHC Reasons for Volunteering Scale, developed for this study through exploratory and confirmatory factor analysis strategies, are brought to bear on questions about the (1) diversity of the volunteer community, (2) the extent to which volunteers are burdened by potentially debilitating AIDS-related experiences, and (3) the promise for the continued effective and inspirational functioning of GMHC suggested by volunteers' reasons for choosing to volunteer at this time. Volunteers, 62% of whom are gay men and 28% are heterosexual women, represent a wide age range but little diversity in race/ethnicity and educational background. They arrive at GMHC 8 years after its founding with a slight majority having had significant prior experience with HIV-related events. There are six basic kinds of reasons for their volunteering, in order of importance: Joining the AIDS Cause, Personal Growth, Social Contact, Helping the Gay Family, Coping with AIDS, and Career Enhancement.

A typology of AIDS volunteers.

Based on our research of volunteers at Gay Men's Health Crisis (GMHC) in New York City, we developed a typology of AIDS volunteers derived from their responses to our Reasons for Volunteering scale. The scale included six basic reasons, three of which were AIDS-specific and three of which represented more general reasons for doing volunteer work. Cluster analysis was used to identify sub-groups in this sample, from which we identified seven distinct and meaningful types of volunteers. One type, which we labeled Self-Sacrificers, is the closest we could find to a group of altruists-volunteers who indicated that self-gain was unimportant to them. While the volunteers who endorsed AIDS-related reasons for volunteering were most likely to be gay men and to have had significant prior AIDS-related experiences, each cluster was markedly heterogeneous in terms of demographic characteristics. Implications are drawn for the management of volunteers in community-based AIDS organizations and for further research on helping behavior and altruism.

An exploration of leadership in a medical mutual help organization.

Studied 45 current leaders of local chapters of a medical mutual help organization. Cluster analysis of variables depicting routes to leadership produced six clusters: Health Professionals with a Mission, Connected Health Professionals, Career Leaders, Grass-roots Founders, Connected Grass-roots Leaders, and Obligated Veterans. These clusters differed on criterion measures of burnout, hardiness, and perceived obligation to continue as a leader, e.g., Connected Health Professionals and Career Leaders were less burned out, more hardy, and perceived less of an obligation to continue in the leadership role than Health Professionals with a Mission. In terms of leadership activities, Help Provision and Advocacy constituted less than one fifth of all activities but were rated as most rewarding. In contrast, the activities that made up the bulk of leaders' work--building membership, system maintenance, and organizational growth--were not rated as particularly rewarding. Results are discussed in the context of research directions and practice.